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Multimodality imaging and long-term outcome after pericardiectomy for constrictive pericarditis: a single center case series
Sub-topic : Cardiac Magnetic Resonance: Pericardium
Session type : Poster Session
Authors : B P Paelinck (Edegem,BE), S Laga (Edegem,BE), D De Bock (Edegem,BE), JM Bosmans (Edegem,BE), MJ Claeys (Edegem,BE), S Haine (Edegem,BE), T Vermeulen (Edegem,BE), PM Parizel (Edegem,BE), IE Rodrigus (Edegem,BE)
Background/introduction: Although constrictive pericarditis (CP) is associated with high morbidity and mortality, the diagnosis of CP often remains challenging. Pericardiectomy is considered the standard therapy for CP. Data on long-term outcome of pericardiectomy are limited. Purpose: To analyze multimodality diagnostic performance, clinical outcome and risk factors for perioperative and long-term complications and survival in patients treated with pericardiectomy for CP. Methods: Single center, retrospective study of patients who underwent pericardiectomy. Data on multimodality imaging (echocardiography, CMR and/or CT) and clinical status at baseline, postoperative and at follow-up were analyzed. Results: Sixteen patients (age 74 years (53-81)) underwent partial (n: 9) or complete (n: 7) pericardiectomy between 2012 and 2018. CMR was performed in 9 patients, CT in 7 patients (pacemaker: 1, alfapump: 1, CT and CMR: 2, no availability of CMR: 3). In 2 patients CP was diagnosed incidentally peroperatively (aortic valve replacement: 1, coronary bypass: 1, both had dyspnea NYHA III). In 14 patients CP was diagnosed preoperatively combining clinical picture (dyspnea NYHA IV (n:4), III (n:8), II (n:2), edema (n: 14), ascites (n:7), pleural effusion (n:10)), preserved left ventricular ejection fraction 60% (45 – 77) (except one patient (LVEF:18%)), high filling pressures but preserved E’, presence of septal bounce (CMR n:9), thickened pericardium =0,4 cm (n:9) and pericardial calcifications (n:5). Late gadolinium enhancement was present in 5 patients. The time duration between onset symptoms and diagnosis was 1 year (3 months – 4 years). CP was confirmed histologically in all patients. CP ethiology was post-radiation (n:1), post-cardiac surgery (n:4), post-pericarditis (n:3), reumatoid arthritis (n:2), renal insufficiency (n:3) and idiopathic in 3 patients. One patient died due to irreversible cardiogenic shock 11 days postop. Postop course was complicated with prolonged hospitalization (15 days (7-107)), prolonged congestion (n:6), pulmonary embolism (n:1) and renal insufficiency (n:7). Follow-up period was 35 months (1-66). Dyspnea dropped to NYHA I (n:9) and NYHA II (n:3) but remained NYHA III in 3 patients despite maintenance of high dosages of diuretics (n:4). Conclusions: CP remains a difficult and even incidental diagnosis, requiring a long diagnostic time period often. A high grade of suspicion for CP in heart failure symptoms (often including ascites and pleural effusion) with normal left ventricular ejection fraction is crucial, complemented by integrative echoDoppler and multimodality imaging (CMR/CT). The choice of one or multiple imaging modalities is driven by the clinical context and availability of each technique. Pericardiectomy is followed by prolonged and complicated postop course often. Identification of risk factors for postoperative complications needs further study.
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